Managing Carpal Tunnel Syndrome

According to recent estimates, carpel tunnel syndrome affects about 2 million people in the United States. The condition is associated with numbness, burning pain, or tingling sensations involving the hands or wrists. Carpel tunnel syndrome occurs when ligaments thicken over the median nerves in the wrists or hands, and repetitive movements cause inflammation. Other factors that may increase the risk for carpel tunnel syndrome include pregnancy, diabetes, obesity, arthritis, and previously broken or dislocated bones in the wrist. Published studies have shown that the syndrome is most common in women between the ages of 40 and 60. Carpel tunnel syndrome makes it difficult for patients to hold objects or to perform repetitive movements, which can severely impact quality of life and work performance.
       Before treatment for carpel tunnel syndrome is provided, it’s important to review a patient’s medical history, conduct a physical examination, and consider diagnostic testing to properly distinguish if pain and other symptoms are being caused by tendonitis or another condition other than carpel tunnel. Nerve conduction velocity tests can help physicians diagnose the condition appropriately; they measure how quickly stimulation travels down the arm and across the wrist. X-rays and electromyograms are also effective diagnostic aids to determine if muscle damage has resulted from nerve compression.
       Use Conservative Treatments First
       Conservative treatments for carpel tunnel syndrome are intended to reduce or eliminate repetitive injury to the median nerve and should be used prior to considering other more invasive options. In some cases, immobilization of the wrist with splints can minimize pressure on the nerves, but this strategy can be cumbersome when used during the day and can inhibit functional ability. Anti-inflammatory medications or cortisone injections administered to the wrist around the nerve can reduce swelling, but these interventions will be beneficial only if the problem is mild or moderate. Physical therapy, massage therapy, and/or range-of-motion therapy can relieve symptoms along with hand and wrist exercises, rest, and/or the use of wrist splints during sleep. Unfortunately, some patients will not benefit from conservative treatment; in these cases, a more thorough diagnostic evaluation should be conducted to determine if surgery is a potential treatment option.
       Surgical Options Improving
       Carpel tunnel release is the most common surgical procedure for the condition and can be performed with either open surgery or endoscopic techniques. Open surgery involves making an incision in the wrist or palm so that the transferse carpel ligament can be cut, allowing for decompression of the median nerve. The incision, however, limits use of the hand for close to 6 weeks during the healing period. Fortunately, endoscopic procedures are improving and give patients another less-invasive option.
       With endoscopic release, a smaller incision is made above and below the ligament, allowing for quicker recovery times. Using miniature cameras, surgeons can view the carpel tunnel and make incisions more precisely to speed the healing process. The endoscopic approach allows patients to return to normal daily activities much quicker than open surgery, but data have shown that there’s a higher risk for severing one of the tendons to the fingers that go under the ligament along with the nerve. Whenever endoscopic surgery is being considered, it’s imperative that surgeons are well-trained and experienced with the technique. The risks of carpel tunnel surgery are minimal and results with surgery are usually excellent, with most patients receiving nearly full relief of their symptoms. The key, however, is to diagnose and treat carpel tunnel syndrome early and accurately so that patients achieve good outcomes.

James R. Bean, MD, has indicated to Physician’s Weekly that he has no financial disclosures.

James R. Bean, MD
President of Neurosurgical Associates, PSC, Lexington, KY
President for American Association of Neurological Surgeons